Emma-Louise Anderson

Infectious Injustice: The political foundations of the Ebola crisis in Sierra Leone

Abstract This article identifies the long-term political factors that contributed to the Ebola crisis in Sierra Leone, factors which are largely overlooked by the emerging international focus on building resilient health systems. We argue that the country exhibits critical symptoms of the recurrent crises of a gatekeeper state, including acute external dependency, patron–client politics, endemic corruption and weak state capacity. A coterie of actors, both internal and external to Sierra Leone, has severely compromised the health system. This left certain sections of the population acutely at risk from Ebola and highlights the need for political solutions to build stronger, inclusive health systems.

Dependent Agency and the AIDS Enterprise: Global Programs, Local Actions

This chapter theorizes about dependent agency and situates the concept in the Malawian and Zambian context. A condition in which people can simultaneously act and be dependent, dependent agency lies on a continuum and manifests itself to various degrees in structures of global power relations and specific environments. In Malawi and Zambia, donor competition, foreign aid uncertainty, development discourses that promote grassroots participation, global norms that define health as a human right, and the rise of the AIDS enterprise shape this global-local context. This chapter concludes by describing the research methodology.

Performing, Extraverting, and Resisting: The Strategies of Dependent Agents

This chapter analyzes strategies of dependent agents, using the empirical data and the works of James C. Scott and Jean-Francois Bayart. Performances of compliance echo donors’ priorities and rhetoric. In extraversion, dependent agents outwardly highlight their dependency using testimonies and claims of donor exclusion. Donor-funded trainings are often the site for learning extraversion motifs and perfecting performances of compliance, and brokers, or people who link donors to community members, may facilitate this learning. Resistance below the line includes using euphemisms, stretching the rules, and foot-dragging. While dynamic, these strategies create leverage that facilitates access to opportunities and resources.

Complex Power on the Margins: The Implications of Dependent Agency

The implications of dependent agency are multifaceted. First, it may influence donors’ ability to achieve their objectives, while also reinforcing the status quo and undermining local solidarity. Second, it may shape democratization by challenging liberal citizenship and undermining transparency and accountability in decision-making. Despite these limitations, dependent agency also illustrates local people’s desire for participation and their nascent demands for the powerful to be held accountable. The work concludes by exploring how the concept of dependent agency may shape scholarship on African politics, international relations, and global health.

Unique Opportunities in a Dynamic Aid Architecture: The Conditions for Agency

Dynamic donor programs create conditions for dependent agency. Increases in AIDS funding in the mid-2000s led to new community-level programs and structures. The 2008–2009 global recession, deteriorating donor–recipient relations, and corruption scandals then caused a slowdown of AIDS monies after 2009. Donors’ priorities shifted from a rapidly scaled-up emergency response to sustaining that response. The dynamic aid architecture provided “wiggle room” for dependent agents, as local people living with HIV responded to the new issues and opportunities that emerged in the AIDS enterprise.

Sex for Well-being

The preceding chapter examined gendered poverty as a form of structural violence and the concern here is to extend the analysis to understand the gendered ways in which life is valued. This is crucial because, as established in chapter 1, health interventions are predicated on western neoliberal conceptualisations of responsible, rational individuals (see Flynn, 2006, p. 83; Beck-Gernsheim, 2000, p. 123; Beck, 1992, p. 135). And yet, knowledge does not tend to result in behaviour change. The intricacies of the gendered ways in which life is valued and the impact upon HIV risk are particularly obscured by responses that are based on ‘best practice’ in other contexts. The value of life is not necessarily visible or measurable. As opposed to the emphasis on a top-down response, understanding how people value life requires local-level expertise.

Sex for Security

The dominant ways of framing and responding to HIV obscure the gender context of risk and, in so doing, undermine the effectiveness of the response. This chapter is the first of two chapters that examine the culturally specific and historically situated complexities of the gendered dimensions of HIV risk in Malawi. The focus here is on examining the ways in which gendered poverty is produced, experienced and responded to. Since Malawi has long been one of the world’s poorest countries, the linkages between poverty and HIV are pertinent. The concern here is the gendered dimensions. As Nattrass et al. (2012, p. 307) propound, ‘poverty and sexual behaviour matter to individuals’ HIV risk, but in gendered ways’ (see also Boesten and Poku, 2009, p. 6).

Framing the Virus

HIV has had a prominent place on the global health agenda as an ‘exceptional’ issue for global governance, attracting unprecedented levels of political commitment and resources as compared to other health concerns (see Smith and Whiteside, 2010; Nguyen, 2010, p. 13). The Global Fund to Fight AIDS, Tuberculosis and Malaria was established in 2001 and up to April 2010, US

Gender on the Agenda

19.3 billion had been committed in 144 countries. Seven grants were awarded to Malawi from October 2003 to 30 June 2010, totalling US

Dependent Agency in the Global Health Regime

460 million (